Objective: We reported that HbA1c levels measured by enzymatic assay (EA) (EA-HbA1c) during off-site health checkups are lower than those measured by on-site high-performance liquid chromatography (HPLC) assay. The HbA1c measurement method of the laboratory facility at our related institution (Hakuhokai Central Hospital) was changed from HPLC assay to EA in February 2017.

Methods: In the present study, we compared the HbA1c levels before and after the change in the measurement method for those who underwent off-site health checkups at our hospital from February 2015 to January 2019. Subjects with fasting plasma glucose ≥126 mg/dL and those under treatment for diabetes mellitus were excluded. We divided the measurement period by HPLC assay (February 2015 to January 2017) and the measurement period by EA (February 2017 to January 2019), and further divided them into four periods for comparison. We also compared HPLC-HbA1c and EA-HbA1c for each adjacent period.

Results: As a result, EA-HbA1c levels were significantly lower than HPLC-HbA1c levels (p<0.001). Moreover, HbA1c levels were significantly lower during the period when HPLC assay was changed to EA in the comparison for each adjacent period (p<0.001).

Conclusion: The low levels of HbA1c were observed as the HbA1c measurement was changed from the HPLC assay to the enzymatic assay. Based on our previous reports, the cause of the low EA-HbA1c level was considered to be hemolysis associated with the transportation of the sample to the laboratory.

Objective: The purpose of this study is to determine the effectiveness of take-out items that are expected to contribute to the continuation of lifestyle-related improvement at home, which were given after specific health guidance.

Methods: After the first interview for health guidance, the participants were asked to bring back a small rice bowl, or toilet paper with health information printed on it, as a take-out item. Approximately three months after starting the health guidance, an evaluation of lifestyle-related improvement was conducted by mail. We compared the effects of lifestyle-related improvement and weight loss on the 154 respondents. Furthermore, for those who underwent a medical examination about a year later, we also compared the changes in body weight.

Results: At the time of evaluation about three months later, the percentage of those who answered that the intake of rice had decreased was high in the rice bowl group. The proportion of those who reported losing 2 kg or more at the time of evaluation was higher in the rice bowl group, although there was no difference between the two groups a year later. More than 90% of the rice bowl group answered that they would continue to use smaller rice bowls.

Conclusions: It was concluded that providing small rice bowls at the time of health guidance provides an opportunity to reduce the intake of rice and it is useful for weight loss. However, in order to maintain weight loss, continued support combined with lifestyle-related habits such as regulating other eating behaviors is necessary.

Objectives: We developed a mask for endoscopy to reduce droplet and aerosol dispersion during upper gastrointestinal endoscopy and validated its efficacy. We also evaluated its acceptability to patients undergoing upper gastrointestinal endoscopy though questionnaires.

Methods and Results: Prototype mask for endoscopy: the mask had a three-layer structure consisting of two layers of non-woven fabric and a water absorption sheet. It had a convex shape similar to a coffee filter with an endoscopic insertion port of 15 mm diameter. Comparative experiment of visualized droplet and aerosol dispersion associated with coughing: To validate the efficacy of the mask, we performed a comparative experiment of droplet and aerosol dispersion by visualizing the breath. The mist from coughing was reproduced in a mannequin model, and the difference in dispersion between wearing and not wearing the mask was determined in terms of the flying distance and maximum velocity of the mist. The results showed that the flying distance of the mist with the mask was one-third of that without the mask, and the maximum velocity of the mist with the mask was half that without the mask. Questionnaire study of examinees: A questionnaire was administered to 204 patients who wore a mask for endoscopy to survey their resistance, discomfort, and sense of security to the mask on a 5-point scale (Yes, Relatively yes, Neither yes nor no, Relatively no, No). The results were as follows: 93.1% and 95.6% answered “Relatively no” or “No” for resistance and discomfort, and 57.4% answered “Yes” or “Relatively yes” for sense of security, respectively. Thus, wearing a mask was acceptable to the subjects.

Conclusion: Wearing a mask for endoscopy is an effective measure for reducing droplet and aerosol dispersion, and possibly contributes to the implementation of safe and secure endoscopy.

Objective: Guidelines for Breast Ultrasound Diagnosis 4th Edition were published in October 5, 2020, in which revisions were made to the recall criteria and category assessment (hereinafter, new criteria) for breast ultrasound screening. This study aimed to investigate the effect of the new criteria on a reduction in the false positive rate. To this end, we examined diagnostic results based on the pre-revision criteria and changes in category assessment based on the new criteria among patients we recently diagnosed as having a mass with a mixed pattern based on the new criteria.

Methods: In total, 12,787 patients underwent breast ultrasound between April 1, 2018 and March 31, 2020, of whom patients diagnosed with or suspected as having a intracystic papilloma that corresponded to a mass with a mixed pattern were investigated. Results were re-analyzed based on the new criteria and compared with those based on the pre-revision criteria. The equipment used included the Canon Aplio300 ultrasound system.

Results: Of the 12,787 patients, 547 underwent recall examination. Sixty-two cases were assessed as intracystic papilloma, of which 51 were assessed as category 3 or above (0.399%; 9.324% of cases requiring a recall examination). Mass size was larger than 15 mm in 3 cases and 15 mm or less in 48 cases. None of these patients had experienced symptoms or associated signs. Malignancy was detected in one case with ductal carcinoma in situ measuring 15 mm or less (0.008%; 0.183% of cases requiring recall examination).

Conclusions: Our results suggest that the present new criteria can narrow down the number of cases requiring recall examination, and thereby reduce the false positive rate and improve the specificity of breast ultrasonography.

Objectives: New lifestyles after the coronavirus infectious disease 2019 (COVID-19) pandemic, such as remote work and no eating out, have become the “new normal.” This study investigated the impact of the COVID-19 pandemic on the health status of the annual Ningen Dock participants.

Methods: We collected data from 5,177 participants who undertook the annual Ningen Dock for 3 consecutive years from 2018 to 2020 fiscal year and analyzed their laboratory data and answers to medical interviews.

Results: The medain body weight changes of the participants between the fiscal year 2019-2020 was +0.2 kg. The proportion of examinees who gained and lost ≥1 kg was significantly higher between the fiscal year 2019 and 2020 than that between the fiscal year 2018 and 2019 (32.8% and 25.4% vs. 29.5% and 22.9%, respectively). The factors associated with lifestyle-related diseases, such as systolic blood pressure (+2.0 mmHg), low density lipoprotein cholesterol (+6 mg/dL) worsened among the participants who gained ≥1 kg. Multivariate analysis accounting for age, sex, smoking status, and eight lifestyle habits determined the age (odds ratio, 0.98), midnight snacking habits (odds ratio, 1.18), walking for ≥1 h a day (odds ratio, 0.77), and irregular sleep schedule (odds ratio, 1.26) as predictors for gaining ≥1 kg. Walking for ≥1 h a day was revealed to be a predictor for losing ≥1 kg (odds ratio, 1.31).

Conclusion: Walking for ≥1 h a day may aid the annual Ningen Dock examinees’ health.

Objective: Isolated aneurysm or superior mesenteric artery (SMA) dissection is a relatively rare condition. We report two cases of isolated SMA dissection detected using health screening ultrasonography. Both cases were asymptomatic middle-aged men who were smokers.

Methods: SMA dissections were detected using health screening ultrasonography from January 2020 to February 2021. SMA lesion was detected in both cases for the first time.

Results: Case 1 was a man in his 50s. He had no symptoms but was a current smoker. Isolated SMA dissection with aneurysm was diagnosed. Case 2 was a man in his 50s. He had no symptoms. He had PH, hypertension, hyperuricemia, and subarachnoid hemorrhage and was an ever smoker. Isolated SMA dissection with aneurysm was diagnosed.

Conclusions: SMA dissections often present as acute stomachache, and asymptomatic cases are rare. Here, we report two cases of asymptomatic SMA dissections. Courtney investigated 77 patients with abdominal artery dissections and reported that 36% of them were asymptomatic. We should examine SMA lesions as far as possible using health screening ultrasonography because SMA aneurysms or dissections are critical.

Objective: To evaluate COVID-19 spread in the Tokyo area, we monitored monthly seropositivity against SARS-CoV-2 at the outpatient clinic and health screening of the Tokyo Midtown Clinic from June 2020 to October 2021.

Methods: To measure antibodies against SARS-CoV-2, we used Elecsys^® anti-SARS-Cov-2 (RUO) system.

Results: From June 2020 to October 2021, 5,315 persons had their first antibody test against SARS-CoV-2. Monthly ratio of seropositivity during the period were 2.0%, 1.2%, 1.2%, 1.5%, 2.9%, 2.7%, 4.1%, 4.3%, 8.8%, 11.3%, 5.9%, 11.3%, 8.3%, 12.6%, 13.7%, 13.8%, respectively. After February 2021, seropositivity was significantly increased. Seropositivities before and after February 15 were 2.5 ± 1.2% and 10.7 ± 2.8% (p=0.001). It reached around 14% when the fifth outbreak started. Analyzing 112 patients who first became seropositive, sixteen (14.3%) were past PCR-positive (A). Fifteen (13.4%) had close contact with COVID-19 patients or cold-like symptoms without positive results of PCR nor diagnostic tests (B). The rest, 81 (72.3%) of them, were asymptomatic (C). Titers of group A were significantly higher than that of group C, 95.3 ± 61.8 vs. 50.7 ± 53.0 (p=0.011). Our seropositivity results were 2.3 times more than the official report in the Tokyo area.

Conclusions: The spread of COVID-19 among socially active adults in Tokyo should be more than expected from PCR positive numbers. They were mostly asymptomatic. There was no case of COVID-19 infection during clinic operations under a strict preventive policy.

Objective: We investigated awareness and feasibility of the food for the prevention of Frailty syndrome when the subjects ate the Ningen Dock lunch developed by us and nursing school students.

Methods: Of the 1,422 people who ate our Ningen Dock lunch for a one-month period from March in 2021, 1,242 people valid, and the response rate was 87.3%. We provided a diet containing 10 different food groups for the prevention of Frailty syndrome. In order to convey the inventor’s thoughts on the prevention and improvement of eating habits, we distributed a “menu” with pictures of students and conducted a questionnaire survey on Frailty syndrome. We investigated awareness and feasibility and compared them between the ages under 60 and over 60 by gender.

Results: The apparent awareness rate of Frailty Syndrome was approximately 15% regardless of gender or age. For the prevention of Frailty Syndrome, the feasibility rate of “have three meals a day” and “chew well when eating” was approximately 80%. It of “10 types of preventive foods” was only 27.4%.

Conclusions: Frail’s awareness is low, and education is important for men and women of all ages. Since it is difficult to practice “10 types of preventive foods”, the challenge is to build health guidance that can be concretely imagined to be incorporated into daily life.

Objective: We investigated the effectiveness of implementation of an inter-facility protocol including a company, a health insurance organization, and a health check-up facility for improving the completion rate of Specific Health Guidance, the dietary and exercise educational program provided under the workplace annual health check-up for a high-risk group of metabolic syndrome, in a large-scale group organization.

Methods: We summarized the steps and activities taken by the project for improving the completion rate of Specific Health Guidance from 2017 to 2020, for developing the protocol. Our protocol includes three main steps: 1) an inter-facility team development and project planning, 2) consensus building among stakeholders and a leader, 3) inter-facility cooperation by divisions of a company, a health insurance organization, and a health check-up facility. The outcomes were defined as annual completion rates of selected participants and were compared with those of 2017.

Results: The completion rates of Specific Health Guidance were increased from 6.4% to 93.6% in three years.

Conclusions: The inter-facility protocol including a company, a health insurance organization, and a health check-up facility could improve the completion rate of Specific Health Guidance to nearly one hundred percent in a large-scale group organization.